摘要
目的探讨氢吗啡酮镇静在纤维支气管镜支气管肺泡灌洗(BAL)治疗呼吸机相关性肺炎(VAP)中的应用价值。方法将60例VAP患者随机分为A组28例与B组32例,分别采用异丙酚与氢吗啡酮行无痛BAL治疗。比较两组不同时间的生命体征和呼吸力学指标变化,以及灌洗过程中镇静评分及不良反应。结果两组术中及术后10 min的心率(HR)、呼吸频率(BR)均较术前明显降低(P<0.05),但B组术的变化幅度明显小于A组(P<0.05)。A组灌洗后60 min及120 min的气管峰压(PIP)、呼吸功(WOB)、吸气阻力(RAW)均较灌洗前明显降低(P<0.05),肺动态顺应性(CD)较灌洗前明显升高(P<0.05);B组灌洗后60 min的PIP、RAW较灌洗前明显降低(P<0.05),CD较灌洗前明显升高(P<0.05),灌洗后120 min的PIP、WOB较灌洗前明显降低(P<0.05),CD较灌洗前明显升高(P<0.05);B组的PIP、WOB、CD、RAW的变化幅度小于A组(P<0.05);两组灌洗过程中镇静评分及不良反应比较均无统计学差异(P>0.05)。结论 BAL治疗VAP患者采用氢吗啡酮镇静,可减少机体应激状态,减少对通气换气功能的影响。
Objective To explore the application value of hydromorphone sedation in the treatment of ventilator-associated pneumonia （VAP） with bronchoscopic bronchial alveolar lavage （BAL）. Methods A total of 60 patients with VAP were selected and randomly divided into group A（n=28） and group B （n=32）. The two groups received indolent BAL treatment with propofol and hydromorphone respectively. The vital signs at different times, the changes in respiratory mechanical indexes, the sedation scores in the process of lavage and the adverse reactions between the two groups were compared. Results The heart rate （HR） and breathing rate （BR） during and 10 min after the operation were much lower than those before the operation（P 〈 0,05）, but the changes in group B were significantly minor in comparison with those in group A （P 〈 0.05）. The peak inspiratory pressure （PIP）, work of breathing （WOB） and resistance in airways （RAW） 60 min and 120 min after lavage in group A were significantly lower than those before lavage （P 〈 0.05）, lung dynamic compliance （CD） was much higher than that before lavage（P 〈 0.05）; the PIP and RAW 60 rain after lavage in group B were much lower than those before lavage （P 〈 0.05）, but CD was significantly higher than that before lavage（P 〈 0.05）; the PIP and WOB 120 min after lavage in group B were much lower than those before lavage （P 〈 0.05）, but CD was significantly higher than that before lavage （P 〈 0.05）; the changes in the PIP, WOB, CD and RAW in group B were minor in comparison with those in group A （P 〈 0.05）; the sedation scores in the process of lavage and adverse reactions showed no statistical difference between the two groups （P 〉 0.05）. Conclusion The application of hydromorphone sedation in the treatment of VAP with BAL can reduce body stress state and the impacts on breathing function.
出处
《西南国防医药》
CAS
2017年第11期1150-1153,共4页
Medical Journal of National Defending Forces in Southwest China
